Provider Demographics
NPI:1083490247
Name:BUILDING BLOCKS DEVELOPMENTAL THERAPY
Entity Type:Organization
Organization Name:BUILDING BLOCKS DEVELOPMENTAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAILESS
Authorized Official - Suffix:
Authorized Official - Credentials:ITFS
Authorized Official - Phone:919-691-0838
Mailing Address - Street 1:5687 SALEM FARM RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-6420
Mailing Address - Country:US
Mailing Address - Phone:919-691-0838
Mailing Address - Fax:
Practice Address - Street 1:5687 SALEM FARM RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-6420
Practice Address - Country:US
Practice Address - Phone:919-691-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health